Penetrating Neck Trauma

2016 ◽  
Author(s):  
Adam R. Kellogg ◽  
B. Witkind Davis
Keyword(s):  
Airway Management ◽  
Diagnostic Testing ◽  
Case Fatality ◽  
Hemodynamic Instability ◽  
Orotracheal Intubation ◽  
Neck Injuries ◽  
Neck Trauma ◽  
Penetrating Neck Trauma ◽  
Surgical Evaluation ◽  
Serious Injuries

Penetrating neck injuries are approximately 1% of all traumatic injuries in the US, yet the case fatality rate approaches 10%. All emergency physicians need to be able to expediently differentiate those requiring emergent interventions from those with less serious injuries. Initial management of penetrating neck injuries focuses on identification of patients requiring early airway management or emergent surgical evaluation. Due to bleeding, anatomic distortion, hemodynamic instability, or potential airway violation patients with penetrating neck trauma should be presumed to have difficult to manage airways. The emergency physician must be prepared to perform cricothyrotomy, and even tracheostomy, should orotracheal intubation attempts fail. Diagnosis of injury in the stable patient with evidence of violation of the platysma has moved away from the traditional zone based approach and now focuses on structured physical exam and the use of MDCTA. Further diagnostic testing may be required dependent on the results of the MDCTA and should be at the direction of a surgeon.   Keywords: Penetrating Neck Trauma, Laryngotracheal Trauma, Carotid Artery Injury, Airway Management, Cricothyrotomy, Surgical Airway, CT Angiography

Fools rush in? airway management in penetrating neck trauma

1993 ◽  
Vol 11 (4) ◽  
pp. 479-480 ◽  
Author(s):  
Ron M. Walls ◽  
Richard Wolfe ◽  
Peter Rosen
Keyword(s):  
Airway Management ◽  
Neck Trauma ◽  
Penetrating Neck Trauma

Penetrating neck injury: case report and evaluation of management

2000 ◽  
Vol 114 (7) ◽  
pp. 554-556 ◽  
Author(s):  
M. Tariq ◽  
A. Kalan ◽  
S. S. Surenthiran ◽  
A. Bhowmik
Keyword(s):  
Case Report ◽  
Surgical Intervention ◽  
Effective Means ◽  
Neck Injury ◽  
Urban Violence ◽  
Neck Injuries ◽  
Neck Trauma ◽  
Specific Approach ◽  
Penetrating Neck Injury ◽  
Penetrating Neck Trauma

Greater urban violence has resulted in an increased incidence of penetrating neck trauma. Penetrating neck wounds can present difficult diagnostic and therapeutic dilemmas. The evaluation and management of such injuries, however, remains controversial. There is no universally accepted specific approach to the management of patients with penetrating neck injuries, with some surgeons advocating mandatory neck exploration whilst others believe in selective surgical intervention.We believe that an equal willingness for both conservative and surgical intervention as dictated by serial bedside evaluation with adequate radiological and endoscopic support can provide the clinician a safe and effective means of managing a potentially complex and lethal problem.

Airway Management for Patients with Penetrating Neck Trauma

1993 ◽  
Vol 77 (6) ◽  
pp. 1135???1138 ◽  
Author(s):  
Vance E. Shearer ◽  
A. H. Giesecke
Keyword(s):  
Airway Management ◽  
Neck Trauma ◽  
Penetrating Neck Trauma

scholarly journals Penetrating neck injuries: a guide to evaluation and management

2018 ◽  
Vol 100 (1) ◽  
pp. 6-11 ◽  
Author(s):  
JL Nowicki ◽  
B Stew ◽  
E Ooi
Keyword(s):  
Life Support ◽  
Neck Injury ◽  
Helical Computed Tomography ◽  
Advanced Trauma Life Support ◽  
Neck Injuries ◽  
Neck Trauma ◽  
Injury Management ◽  
Operative Exploration ◽  
Penetrating Neck Injury ◽  
Penetrating Neck Trauma

IntroductionPenetrating neck injury is a relatively uncommon trauma presentation with the potential for significant morbidity and possible mortality. There are no international consensus guidelines on penetrating neck injury management and published reviews tend to focus on traditional zonal approaches. Recent improvements in imaging modalities have altered the way in which penetrating neck injuries are now best approached with a more conservative stance. A literature review was completed to provide clinicians with a current practice guideline for evaluation and management of penetrating neck injuries.MethodsA comprehensive MEDLINE (PubMed) literature search was conducted using the search terms ‘penetrating neck injury’, ‘penetrating neck trauma’, ‘management’, ‘guidelines’ and approach. All articles in English were considered. Articles with only limited relevance to the review were subsequently discarded. All other articles which had clear relevance concerning the epidemiology, clinical features and surgical management of penetrating neck injuries were included.ResultsAfter initial resuscitation with Advanced Trauma Life Support principles, penetrating neck injury management depends on whether the patient is stable or unstable on clinical evaluation. Patients whose condition is unstable should undergo immediate operative exploration. Patients whose condition is stable who lack hard signs should undergo multidetector helical computed tomography with angiography for evaluation of the injury, regardless of the zone of injury.ConclusionsThe ‘no zonal approach’ to penetrating neck trauma is a selective approach with superior patient outcomes in comparison with traditional management principles. We present an evidence-based, algorithmic and practical guide for clinicians to use when assessing and managing penetrating neck injury.

scholarly journals Conservative management of laryngeal perforation in a rural setting: case report and review of the literature on penetrating neck injuries

CJEM ◽  
2011 ◽  
Vol 13 (02) ◽  
pp. 127-132 ◽  
Author(s):  
Michael R. Kolber ◽  
Anne Aspler ◽  
Richard Sequeira
Keyword(s):  
Case Report ◽  
Care Management ◽  
Standard Of Care ◽  
Rural Setting ◽  
Neck Injuries ◽  
Review Of The Literature ◽  
Significant Morbidity ◽  
Neck Trauma ◽  
Penetrating Neck Trauma ◽  
Rule Out

ABSTRACTPenetrating neck injuries (PNIs) are infrequent but can result in significant morbidity and mortality. Although surgical management of unstable patients with penetrating neck trauma is the standard of care, management of stable patients remains controversial owing to the possibility of occult injuries. Recent studies suggest that physical examination and ancillary imaging may be sufficiently accurate to diagnose or rule out surgically significant injuries in PNI. We report a patient with a laryngeal perforation who was managed conservatively in a rural hospital without complications and review the literature pertinent to cases of this nature.

Airway Management in a Patient With Tracheal Disruption due to Penetrating Neck Trauma With Hollow Point Ammunition

2018 ◽  
Vol 10 (9) ◽  
pp. 242-245
Author(s):  
Angela M. Johnson ◽  
James L. Hill ◽  
Dave J. Zagorski ◽  
Joseph M. McClain ◽  
Nicole C. Maronian
Keyword(s):  
Airway Management ◽  
Neck Trauma ◽  
Penetrating Neck Trauma ◽  
Tracheal Disruption

Airway management, penetrating neck trauma

1993 ◽  
Vol 11 (4) ◽  
pp. 381-385 ◽  
Author(s):  
J. Todd Eggen ◽  
Robert C. Jorden
Keyword(s):  
Airway Management ◽  
Neck Trauma ◽  
Penetrating Neck Trauma

scholarly journals Penetrating Neck Injury: Mandatory exploration versus conservative approach

2016 ◽  
Vol 9 (4) ◽  
Author(s):  
Muhammad Hamid Majid ◽  
Mahmood Ayyaz ◽  
Faraz Fahim
Keyword(s):  
Hospital Stay ◽  
Anatomical Landmarks ◽  
Conservative Approach ◽  
Neck Injuries ◽  
Neck Trauma ◽  
Cervical Trauma ◽  
Mortality And Morbidity ◽  
Conservative Group ◽  
Penetrating Neck Injury ◽  
Penetrating Neck Trauma

This study is designed to investigate the outcome of patients managed on both conservative as well as operative protocols and then compare the two groups for morbidity and mortality. It is a comparative study comparing the groups of patients with operative and non operative intervention done for penetrating neck trauma at Mayo Hospital Lahore for a period of six years from September 1995 to August 2001. All patients of age more than 12 years of age presenting with penetrating cervical trauma in our emergency were included in study. In patients with multiple injuries mortality and morbidity of only cervical trauma was compared. Neck was divided in to three zones according to recognized anatomical landmarks. In conservative group 38.9% developed complications where as in other group 46.4%, developed complications This difference was not significant (p=0.05) Mean hospital stay was 10 days in the conservative group where as 4 days in other group which was statistically significant. Hence we conclude that patients with penetrating neck injuries who are clinically stable can be managed conservatively after appropriate investigations.

scholarly journals Role of Tracheostomy in Dealing with Penetrating Neck Trauma: A Double Edged Sword

2021 ◽  
Vol 2 (1) ◽  
pp. 27-30
Author(s):  
Rohit Bhardwaj
Keyword(s):  
Airway Management ◽  
Neck Exploration ◽  
Neck Trauma ◽  
Case Presentation ◽  
Platysma Muscle ◽  
Laryngeal Injury ◽  
Penetrating Neck Trauma ◽  
Life Threatening ◽  
Lower Site

Background Penetrating neck trauma is an injury in which platysma muscle in neck is breached. It is a life threatening emergency and it requires urgent management by securing airway and neck exploration. Tracheostomy is one of the important procedures as it secures the airway though associated with complications and morbidity in the patients. Case Presentation We present 3 cases of penetrating neck trauma. Each patient is managed by different means of securing airway depending on the site of trauma and associated laryngeal injury. Conclusion Tracheostomy in penetrating neck trauma helps in securing the airway and paves way for safe neck exploration. Minor laryngeal injuries are managed conservatively in order to avoid complications associated with tracheostomy. Tracheostomy and other means of airway management in penetrating neck trauma depend mainly on individualised approach though tracheostomy at a lower site to that of wound should be preferred in major laryngeal injuries. Keywords: Penetrating Neck Trauma; Tracheostomy; Laryngeal Injuries; Airway Management.

scholarly journals Geographic and demographic heterogeneity of SARS-CoV-2 diagnostic testing in Illinois, USA, March to December 2020

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Tobias M. Holden ◽  
Reese A. K. Richardson ◽  
Philip Arevalo ◽  
Wayne A. Duffus ◽  
Manuela Runge ◽  
...  
Keyword(s):  
Diagnostic Testing ◽  
Case Fatality ◽  
The United States ◽  
Test Volume ◽  
Demographic Groups ◽  
Demographic Heterogeneity ◽  
Large Expansion ◽  
Matched Case ◽  
Geographic Regions ◽  
Hispanic White

Abstract Background Availability of SARS-CoV-2 testing in the United States (U.S.) has fluctuated through the course of the COVID-19 pandemic, including in the U.S. state of Illinois. Despite substantial ramp-up in test volume, access to SARS-CoV-2 testing remains limited, heterogeneous, and insufficient to control spread. Methods We compared SARS-CoV-2 testing rates across geographic regions, over time, and by demographic characteristics (i.e., age and racial/ethnic groups) in Illinois during March through December 2020. We compared age-matched case fatality ratios and infection fatality ratios through time to estimate the fraction of SARS-CoV-2 infections that have been detected through diagnostic testing. Results By the end of 2020, initial geographic differences in testing rates had closed substantially. Case fatality ratios were higher in non-Hispanic Black and Hispanic/Latino populations in Illinois relative to non-Hispanic White populations, suggesting that tests were insufficient to accurately capture the true burden of COVID-19 disease in the minority populations during the initial epidemic wave. While testing disparities decreased during 2020, Hispanic/Latino populations consistently remained the least tested at 1.87 tests per 1000 population per day compared with 2.58 and 2.87 for non-Hispanic Black and non-Hispanic White populations, respectively, at the end of 2020. Despite a large expansion in testing since the beginning of the first wave of the epidemic, we estimated that over half (50–80%) of all SARS-CoV-2 infections were not detected by diagnostic testing and continued to evade surveillance. Conclusions Systematic methods for identifying relatively under-tested geographic regions and demographic groups may enable policymakers to regularly monitor and evaluate the shifting landscape of diagnostic testing, allowing officials to prioritize allocation of testing resources to reduce disparities in COVID-19 burden and eventually reduce SARS-CoV-2 transmission.

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